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Organization
T. GERALD O'DANIEL M.D., PLLC
Active
Organization
T. GERALD O'DANIEL M.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. T. GERALD O'DANIEL M.D., PLLC (SOLE PROPRIETOR)
(502) 584-1109
Entity
Organization
Contact information
Practice address
222 S 1ST ST, SUITE 100, LOUISVILLE, KY 40202-1350
(502) 584-1109
(502) 589-6882
Mailing address
222 S 1ST ST, SUITE 100, LOUISVILLE, KY 40202-1350
(502) 584-1109
(502) 589-6882
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
24070
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000219660
ANTHEM PIN
KY
01
—
002
CIGNA
KY
05
—
100033340A
—
IN
01
—
1058697
PASSPORT PIN
KY
05
—
64240708
—
KY
01
—
667357
HEALTHLINK
KY
01
—
KY0057799
TRICARE
KY
01
—
KY1118
HEALTHNET
KY
Enumeration date
01/31/2007
Last updated
10/28/2010
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